Claims Processor

This is a fully remote position, open to applicants in Texas.

📋 Description

• Promptly and accurately review and process medical claims submitted by members or providers.

• Verify the completeness and accuracy of claim information, including patient demographics, diagnoses, procedures, and available billing codes.

• Ensure adherence to insurance policies and industry standards.

• Investigate and resolve any discrepancies or issues related to claim submissions.

• Conduct thorough medical claims audits to identify errors, discrepancies, or fraudulent activities.

• Analyze claim documentation, including medical records and billing statements, to ensure compliance with coding guidelines and reimbursement policies.

• Research complex medical billing and coding issues to support claims processing and auditing activities.

• Interpret coding guidelines, reimbursement policies, and legal requirements to determine proper claim adjudication.

• Provide recommendations for enhancing claims submission processes and improving reimbursement accuracy.

• Act as the primary point of contact for members regarding claims inquiries and resolutions.

• Respond to customer inquiries and concerns with professionalism and empathy in a timely manner.

• Collaborate with cross-functional teams to address customer issues and ensure prompt resolution.

⛳️ Requirements

• High School Diploma or equivalent.

• Demonstrated experience in medical claims processing and healthcare reimbursement.

• Strong understanding of medical terminology, medical coding, and insurance billing practices.

• Technical Skills: Experience with SalesForce, Google Suite, and Claims Management Software.

• Excellent analytical abilities to interpret complex healthcare regulations and guidelines.

• Exceptional attention to detail and accuracy in data entry and documentation.

• Effective verbal and written communication skills with a customer-oriented approach.

• Ability to work both independently and collaboratively in a fast-paced, deadline-oriented environment.

• Must be a self-motivated and proactive individual.

• Strong time management skills.

• Capability to multitask and succeed in a fast-paced, team-oriented environment.

• Must adapt well to change and effectively set and adjust priorities as necessary.

🏝️ Benefits

• Competitive salary and benefits package.

• Dynamic and innovative work environment.

• Opportunities for professional growth and development.

• Remote work.